Prescribing medications during the COVID-19 pandemic

During the COVID-19 pandemic, physicians are being asked to make amendments to existing prescribing practices to ensure patients receive their medication while also following the requirements to distance themselves physically, self-isolate or quarantine.

Several changes have been made to enable this:

1. Legislation

Health Canada has amended the Controlled Drugs and Substances Act (CDSA) and its Regulations to permit pharmacists to extend prescriptions, transfer prescriptions, and deliver controlled medications, and to permit physicians to issue verbal orders for controlled medications.

Accordingly, the College of Pharmacists of BC has amended its bylaws relating to the Pharmacy Operations and Drugs Scheduling Act (PODSA) and the Health Professions Act (HPA) such that they can accept verbal or fax prescriptions for medications that fall under the Controlled Prescription Program (i.e. those requiring a duplicate prescription).

In addition, for controlled prescriptions including opioid agonist treatment (OAT), BC pharmacists can:

  • extend prescriptions
  • provide emergency supplies of the medication
  • transfer prescriptions to another pharmacy
  • deliver medications to patients when it is safe to do so

2. Clinical guidelines and practice standards

BC Centre on Substance Use

Clinical guidelines for prescribing for substance use disorder have also changed. Refer to the BC Centre on Substance Use for updated guidance on prescribing opioid agonist treatment, and managing other substance use disorders during the COVID-19 pandemic.

Physicians are asked to work proactively with their patients and pharmacists to ensure that they have an adequate and uninterrupted supply of essential medications. In formulating such plans, physicians must take into consideration strategies that facilitate physical distancing, minimize travel, minimize unnecessary office and clinic visits, and ensure patients have an adequate amount of medication if they need to self-isolate or self-quarantine.

College of Physicians and Surgeons of BC

None of the College standards create barriers to facilitating adequate and safe supply of medications to patients. Physicians should assess the prescription needs of their patients and assess risks and benefits to both the patient and the public.

Physicians must use good professional judgment and exercise prudent clinical practice (including using distance medicine and virtual care) during this crisis. The College expects that physicians will make decisions in good faith and with patient and public safety as a principal consideration.

3. Telemedicine

During this time, it is reasonable and expected that physicians increase phone or video consultations with patients. This will have an impact on prescribing. Enhanced collaboration with community pharmacists is required.

Physicians should consider the following:

  • For non-controlled medications:
    Renew prescriptions by phone or fax to a pharmacy after a phone conversation or telemedicine visit with a patient and eliminate the need for a patient to obtain an original paper prescription with a wet signature, which they then have to take to a pharmacy. It is not acceptable to text or email photographs of prescriptions from a phone as photographs contain patient information and these are retained (often on cloud-based servers in other countries), which inevitably increases the risk of an information/privacy breach.
  • For controlled medications (such as narcotic pain medication):
    Phone or fax a prescription to a pharmacist (and deliver the original duplicate form). This should only be done if the physician has a longitudinal relationship with a patient and understands their care needs. This may entail prescribing for longer durations; physicians must weigh the benefits of larger dispenses with the risk of overdose or diversion. Patients on long-term opioids should have naloxone kits.
  • For opioid agonist treatment (OAT):
    Ensure patients have a steady supply of these essential medications. This might include alternatives to daily witnessed ingestion such as more frequent delivery of medications. In certain circumstances this could include more take-home doses (“carries”) if the patient is stable on their OAT. Consider rotations to medications with lower risk of overdose and diversion (such as buprenorphine/naloxone preparations) if carries of methadone or sustained-release morphine present too much risk.
  • PharmaNet:
    Physicians are expected to take full medication histories and to check PharmaNet whenever possible to ensure safe prescribing.